CHAPTER II. 

 SCAPULA. 



FRACTURES. EPIPHYSEAL SEPARATION. 



Fracture of the Scapula is rare, and, when it 

 does occur, may be of the body of the bone, of the neck, of 

 the coracoid or of the acromion process. Fracture of the 

 body depends, as a rule, on great force directly ap- 

 plied, because of the 'deep situation of the bone, and, when 

 present, its recognition is difficult on account of the degree 

 of swelling that rapidly ensues. Crepitus is not always 

 evident, since the fragments may overlap, or, on the other 

 hand, may be so much separated by the muscles attached 

 to them that it would be almost impossible to elicit crepi- 

 tation. To assist in the diagnosis of fracture of the body 

 the posterior border and the inferior angle should be made 

 as prominent as possible, and this may be done as follows : 

 For the posterior border place the hand of the injured 

 limb on the patient's opposite shoulder, and for the infe- 

 rior angle have tihe arm of the injured side rest behind the 

 back. By fracture of the neck is meant a fracture start- 

 ing from the suprascapular notch and running down to 

 the infraglenoid tubercle, so as to break off the whole 

 glenoid fossa with the coracoid process attached. The ex- 

 tent of the deformity in this fracture will depend on 

 whether the coraco-clavicular ligament, which holds the 

 coracoid up to the clavicle, be torn or not. When the lig- 

 ament is torn the deformity is quite evident, since the arm,, 

 with the separated fragment, will sink downwards, with 

 the result that a depression occurs under the acromion, 

 somewhat resembling the deformity in dislocation at the 

 shoulder joint, although not so pronounced. Crepitus 

 and the immediate recurrence of the. displacement, when- 

 ever, after reduction, the arm is left unsupported, are the 

 chief diagnostic features of this variety of fracture. A 



